tbuckley/cabot-search huggingface dataset:
Assessing the risk of gastrointestinal cancers among cannabis users compared to nicotine users.
Authors: Shanawar Ali Waris, Rahul Raiker, Nanda Siva, Osama Boustany, Haig Pakhchanian, Ahmed A. Khalid
Journal: Journal of Clinical Oncology (2023)

10571 Background: Exposure to nicotine is a well-studied preventable cause of numerous malignancies, while the association of cannabis use with the development of cancer is not clear. Cannabis contains both carcinogens as well as compounds with antitumor activity, which inhibit chronic inflammation. The aim of this study is to assess the risk of gastrointestinal malignancy in cannabis users compared to nicotine users. Methods: A retrospective cohort study was conducted using TriNetX, a federated database of ~100 million patient records. Adult patients (≥18 years) were queried by ICD-10 coding to find variables of interest. Two groups were created: one group with a history of only cannabis use and the other with a history of only nicotine use. Then lifetime risk of nine different gastrointestinal cancers were assessed and compared between the two groups. 1:1 propensity score matching was conducted, adjusting for comorbidities and demographics, to calculate adjusted risk ratios (aRR) with 95% Confidence Interval for the comparative analysis. Results: A matched cohort of 413,628 patients revealed that cannabis only patients had a significantly lower lifetime risk of developing esophageal cancer (aRR[95%CI]): (0.456[0.364,0.572]), gastric cancer (0.492[0.41, 0.60]), pancreatic cancer (0.547[0.47,0.64]), liver &amp; intrahepatic bile ducts cancer: (0.728[0.70,0.75]), colon cancer (0.351[0.32,0.38]), rectosigmoid cancer (0.699[0.59,0.83]), and rectal cancer (0.563[0.46,0.68]). No significant differences were seen for small intestinal cancer (1.21[0.88,1.6]) and anal cancer (0.87[0.67,1.14]). Conclusions: The results of this study suggest that the lifetime risk of developing numerous gastrointestinal malignancies is lower in cannabis users when compared to nicotine users. It is not clear if this relative risk reduction is due to the beneficial effects of cannabis or a lack of nicotine consumption and its associated effect on carcinogenesis. Long-term studies following cannabis users may provide a better understanding of the association of cannabis use with the risk of developing various malignancies. Additionally, the quantity of exposure to cannabis and its association with the risk of cancer should be further investigated. [Table: see text]
Opiate use after total hip arthroplasty for metastatic bone disease.
Authors: Gayathri Vijayakumar, Dylan Vance, Matthew W. Colman, Steven Gitelis, Kyle Sweeney, Alan T. Blank
Journal: Journal of Clinical Oncology (2023)

e24132 Background: Metastatic bone disease (MBD) commonly affects the hip and surgical intervention including total hip arthroplasty (THA) may be indicated for pain relief or to improve function. Following THA, patients are often prescribed short courses of opioids for postoperative pain relief. This study investigated postoperative opioid use following THA in MBD patients. Methods: This was a retrospective review of patients using opioids preoperatively who underwent THA for MBD at two institutions between 2009 and 2022. Preoperative and postoperative opioid usage at 6 weeks and 90 days were quantified through calculating daily morphine milligram equivalents (MME) and compared using the sign test. Results: Nineteen primary THA and 11 THA with complex acetabular reconstruction were included. At six weeks, 26 (86.7%) patients were utilizing opiates and at ninety days 23 (76.7%) patients were utilizing opiates. There was a statistically significant difference between median daily preoperative MME compared to daily MME at ninety days (p &lt; 0.001). The only statistically significant association with opioid use at 90 days was opioid use at 6 weeks. Conclusions: To our knowledge, this is the first paper evaluating postoperative opioid use following primary THA in MBD patients. After THA in the setting of MBD, patients exhibit decreased postoperative opioid use.[Table: see text]
Outcomes of patients with advanced EGFR mutant lung cancer treated with first line (1L) osimertinib (osi) who would not have met eligibility criteria for the FLAURA trial.
Authors: Connor Wells, Monica Mullin, Sophie Sun
Journal: Journal of Clinical Oncology (2023)

9072 Background: Osi is a 1L therapy for EGFR mutant lung cancer based on the results of the FLAURA clinical trial. Patients on clinical trial are typically highly selected and the overall effectiveness of therapies may be lower in the real-world setting. We report the real-world outcomes of patients treated with first line osi and compare the outcomes of trial eligible and ineligible patients. Methods: Pharmacy records from January 2020 to October 2022 were used to retrospectively identify patients who received 1L osi for advanced EGFR mutant (exon 19 del. or exon 21 L858R) lung cancer in British Columbia, Canada. Patients were deemed ineligible for the FLAURA trial if they met one of five criteria: ECOG ³2, unstable brain metastases (symptomatic or on steroids), hemoglobin &lt;90, platelet &lt;100, or creatinine clearance &lt;50. Comparisons of overall survival (OS) and time to treatment discontinuation (TTD) were made between using Kaplan-Meier survival curves and log-rank testing. Hazard ratios (HR) are reported using Cox regression adjusting for baseline factors (Table). Results: Of 312 patients included, 133 (43%) were considered FLAURA-ineligible. Reasons for ineligibility were poor ECOG (n=120 [including ECOG 2=69, ECOG 3=48, and ECOG 4=4]), unstable brain metastases (n=21), anemia (n=7), thrombocytopenia (n=5), and low creatinine clearance (n=9). Median follow up was 22.7 months. At the time of analysis, 103/133 (77%) of ineligible patients had discontinued osi and 87/133 (65%) had died. 82/179 (45%) of eligible patients had discontinued osi and 53/179 (30%) were deceased. The median TTD in the ineligible group was 11.9 months (95% CI 10.5-15.5) vs 26.9 months (95% CI 21.9- 34.6) in the eligible group (p&lt;0.001), HR 2.1 (95% CI 1.5-2.9, p&lt;0.001). The median OS in the ineligible group was 15.8 months (95% CI 12.4 to 21.1) vs NR [not reached] (95%CI 28.5 to NR) in the eligible group (p&lt;0.001), HR 2.6 (95% CI 1.8-3.7, p&lt;0.001). Rates of dose reduction for toxicity were similar between ineligible (25%) and eligible (19%) patients (p=0.25). Second-line therapy was received by 28/102 (27%) of trial ineligible patients and 46/82 (56%) of trial eligible patients. Conclusions: Over 40% of the real-world population receiving 1L osi would have been ineligible for the FLAURA clinical trial. These patients had significantly inferior outcomes. This study provides benchmark data to better inform patient prognosis using real-world data. [Table: see text]
Defining an abnormal geriatric assessment for older adults with cancer: Which deficits matter most?
Authors: Anthony Carrozzi, Shabbir M.H. Alibhai
Journal: Journal of Clinical Oncology (2023)

12039 Background: At present, there is no universal, objective, and evidence-based definition of what constitutes an abnormal geriatric assessment (GA) in geriatric oncology (GO). In the literature, a threshold number of abnormal GA domains (ranging from 1-4) is often used to define an abnormal GA. However, it is not well-established whether having a specific number of abnormal domains more frequently leads to treatment plan modification (TPM), a key goal of GA, or if particular domains have a greater impact on TPM. The primary objectives of this study are: (1) to determine how well the current definitions of an abnormal GA predict TPM following GA, and (2) to identify particular GA domains associated with TPM. Methods: A retrospective review of the GO clinic database at Princess Margaret Cancer Centre was conducted. All new patients seen in clinic from May 22, 2015 to June 10, 2022 who met the following criteria were included: (1) referred for treatment decision making, (2) received a complete GA, and (3) had a proposed oncologic treatment plan. Demographic, oncologic, and GA-domain variables were extracted. Univariate and multivariate logistic regression modelling was conducted using SPSS to determine each variable’s association with TPM; age, sex, frailty (VES-13) score, and treatment intent were included in all multivariate models. Area under the curve (AUC) was calculated for each model. Results: The study cohort (n = 736) had a mean age of 80.7 years (61-100), 46.1% was female, and 78.3% had a VES-13 score indicating vulnerability. In univariate analysis, age, VES-13 score, disease stage, treatment intent, all GA domains (except Medication Optimization and Social Supports), and all threshold numbers of abnormal domains (except 1 and 7) were significantly associated (p-value &lt; 0.050) with TPM. The best-performing threshold number of abnormal domains in univariate analysis was 4 (AUC 0.628). Overall, the best-performing multivariate model based on AUC was the model containing all 6 significant GA domains (AUC 0.710). In this model, age, treatment intent, Comorbidities, Falls Risk, and Cognition were independently associated with TPM (p-value &lt; 0.05). The multivariate model with a threshold of 4 abnormal domains alone had an AUC of 0.689 and age, VES-13 score, treatment intent, and the threshold were independently associated with TPM. Of the models which included a single GA domain plus the threshold, the models with Comorbidities and Cognition performed best, having AUCs of 0.699 and 0.700, respectively. Conclusions: Overall, our results suggest that an abnormal GA (leading to TPM) may be best defined as one with abnormalities in the domains of Comorbidities, Falls Risk, and Cognition. In terms of a strictly numerical threshold, a GA may be best defined as abnormal if at least 4 GA domains are abnormal. When at least 4 GA domains are abnormal, abnormalities in Comorbidities and Cognition appear to best predict TPM.
First-line HDACi plus tislelizumab combined with chemotherapy in advanced NSCLC.
Authors: Lijie Wang, Ming Gao, Wenyu Yang, Chunyu Wang, Ting Wang, Fangfang Jing, Junxun Ma, Fan Zhang, Haitao Tao, Yi Hu
Journal: Journal of Clinical Oncology (2023)

e21100 Background: Resistance to ICIs remains a challenge. HDAC inhibitors may synergize with PD-1 antibodies by inducing and activating NK cell and cytotoxic T cell (CTL) -mediated cellular immunity. Tislelizumab is an anti-PD-1 mAb approved for the treatment of NSCLC. Chidamide, a subtype-selective HDACi. This Phase 2 study assessed antitumor activity and tolerability of chidamide and tislelizumab combined with chemotherapy in advanced NSCLC. Methods: This was an open-label, prospective study. Patients with histologically or cytologically confirmed NSCLC (stage IIIB-IV) without prior systemic treatment was enrolled. EGFR/ALK mutation or fusion and symptomatic brain metastases were ineligible. Patients received chidamide 20 mg twice weekly orally, tislelizumab 200 mg Q3W intravenously, chemotherapy Q3W(≤4~6 cycles) until unacceptable toxicity, withdrawal of consent, or death. The primary endpoint was ORR. Secondary endpoints include DCR、PFS、OS and safety. Tumor response was assessed using RECIST v1.1. Results: 20 patients were enrolled in the study. At the data cut-off February 10, 2023, the median age was 63.5 years (range: 49-75) and all patients were male 90% of who with smoking history. Most patients were stage IV(95%) .40% of the patients whose PD-L1 expression was positive (PD-L1 TPS≥1%) . The confirmed ORR was 75%(95%CI:56.0-94.0) and 1 patient was evaluated as CR. The DCR was 100%. The median follow-up was 13.1 months, median PFS was 11.7 months (95%CI:7.4m-16.0m) and 1-year PFS rate was 55.6% (95%CI:43.7%-67.5%). Median OS was not reached. 11 patients (55.0%) had ≥ Grade 3 TRAEs. The most common ≥Grade 3 TRAEs were leukopenia (25.0%), neutropenia (20.0%) and thrombocytopenia (15%). Conclusions: Adding HDACi(Chidamide) plus Tislelizumab combined with chemotherapy showed encouraging antitumor activity and a favorable safety profile as first-line therapy for advanced NSCLC. Clinical trial information: ChiCTR2000041542 . [Table: see text]
A multivariate analysis of low-dose CT lung cancer screening in a Michigan community hospital network.
Authors: Jason Law, Borys Hrinczenko
Journal: Journal of Clinical Oncology (2023)

10576 Background: Lung cancer is the leading cause of cancer deaths in the United States. The USPSTF recommended screening for lung cancer with low-dose chest computer tomography (LDCT) in 2013. This was based on the National Lung Screening Trial (NLST) which showed a 20% relative reduction in mortality from LDCT compared with chest radiography in high-risk individuals. The major NLST eligibility criteria were age 55-74, a 30 + pack year smoking history and current smoking status or having quit in the last 15 years. The impact of other risk factors on screening results besides inclusion criteria is unknown. We sought to identify other factors for the risk of lung cancer detection in screened individuals. Methods: This was a retrospective cohort study employing a Michigan based McLaren Hospital Network Lung Cancer Screening Program (LCSP) database from 2015-2022. Participant eligibility in screening was the USPSTF criteria except for an age range of 50-80. Analyses were stratified by BMI, smoking pack-years, insurance status, smoking status, sex, other CT findings, pre- vs. during COVID pandemic (before and after January 2020). Multivariate logistic regression analysis was used for odds ratios (OR) with 95% confidence intervals (CI) as estimates of the relative risk of an elevated Lung-RADS category ≥3 (high risk of detecting lung cancer). Results: A total of 2638 subjects, 49.91% females, 50.09% males, mean BMI 29.50 ± 7.17 (SD), pack-years 44.52 ±18.29, Medicaid 6.66%, Medicare 32.01%, Private Insurance 57.62%, Self-pay /unknown 3.71%. Current smoker 65.49%, Former smoker 34.51%, other CT findings 51.99%, pre-COVID 46.08%, during COVID pandemic 53.92%. Lung-RADS category 0 (0.04%), 1 (35.33%), 2, (50.61%), 3 (6.56%), 4a (4.85%), 4b (1.55%), 4x (1.06%). A statistically significant association with a Lung-RADS category ≥3 was found with lower BMI, OR=0.980 (95% CI, 0.969-0.991), p=0.0005, and female gender, OR=1.232 (95% CI, 1.039-1.462), p=0.0166 (Table). Conclusions: In our study cohort a lower-than-average BMI and also female gender were statistically correlated with an elevated Lung-RADS category ≥3. These findings might be incorporated into a risk stratification model, however further larger studies are needed to validate our findings. [Table: see text]
Effect of bevacizumab plus double dose icotinib on advanced non-small cell lung cancer with EGFR L858R mutation.
Authors: Zhansheng Jiang, Yong Li, Zhuchen Yan, Lan Lan, Xinwei Zhang, Baozhu Ren, Fei Wang, Wencheng Zhang, Zhanyu Pan
Journal: Journal of Clinical Oncology (2023)

e21020 Background: Double-dose icotinib has been proven effective and well tolerated for advanced NSCLC patients with the Epidermal Growth Factor Receptor (EGFR) L858R mutation. For the same patients, the excellent efficacy of bevacizumab combined with erlotinib has been proven in previous studies. In this study, we would investigate the efficacy of the combined therapy bevacizumab and double-dose icotinib for advanced NSCLC patients with EGFR L858R mutation. Methods: 35 patients diagnosed from September 2, 2021 to September 28, 2022 were enrolled in this study and 5 patients were excluded for analysis due to missing efficacy evaluation data. All patients were treated with intravenous bevacizumab (15mg / kg) combined with oral double-dose icotinib (250mg, tid). The primary endpoint was progression-free survival (PFS), and the secondary endpoints were safety, efficacy, and overall survival (OS). Results: Among the 35 patients, 12 were male and 23 were female. The median age at diagnosis was 66. Eight patients were diagnosed with brain metastases. All of the patients have EGFR L858R mutation, and 14 patients were with other coexisting mutations. To the data of December 31, 2022, the median follow-up time was 10 months (range: 3 to 18 months). For 30 patients with complete efficacy evaluation data, 20 patients achieved partial responses (PR), 9 patients had stable disease (SD), and 1 patient developed progress disease (PD). The objective response rate (ORR) was 66.7%, the disease control rate (DCR) was 96.7%, and the median PFS was 14.8 months. For adverse reaction evaluation, the grade 3 adverse events were albuminuria (n = 1) and hepatotoxicity (n = 1). Other adverse events were grade 1-2, mainly oral mucositis, rash, diarrhea and hypertension. Conclusions: The combination of bevacizumab with double-dose icotinib is an effective and relatively safe treatment for advanced NSCLC patients with EGFR L858R mutation. Further exploration will provide more evidence for this type of treatment. Clinical trial information: NCT05263947 .
The impact of 4R Care Delivery Model on timing and sequence of bone density screening among breast cancer patients.
Authors: Carolyn Brookhart, Christine B. Weldon, Julia R. Trosman, Zheng Zhu, Elizabeth Shurell Linehan, Amy Ying Ju Lin, Thea Abbe, Lori C. Sakoda, Nancy P. Gordon, Arliene Ravelo, Aida Shiraz, Marilyn L. Kwan, Raymond Liu
Journal: Journal of Clinical Oncology (2023)

e24061 Background: Bone loss is common in patients with breast cancer and can impact treatment decisions related to endocrine therapy. Hence, bone density assessment prior to start of endocrine therapy is highly important, especially because endocrine therapy is recommended as the first line of adjuvant treatment in patients with ER+ breast cancer. However, implementing bone density assessment in a timely manner is challenging, particularly early in the care trajectory, which involves many specialties and includes many other tests and procedures. We conducted a care delivery optimization in a large health system to implement bone density testing and referral for bone health consultation prior to endocrine therapy. The optimization was conducted as part of implementing the 4R Oncology model (Right Info, Right Care, Right, Right Patient, at the Right Time), a novel approach to optimizing patient-facing care planning, team-based delivery and patient self-management. Here we describe the impact of this optimization. Methods: A cohort of 278 women with breast cancer who were in the 4R intervention (the 4R cohort) was compared to a historical control cohort of 201 women who received care pre-4R. Demographic, bone health history, and oncologic care data were abstracted from chart review and clinical databases. The prevalence of bone loss and timing of bone density consultation request was compared between the 4R and historical control cohorts. Results: The age, race/ethnicity and rate of ER+ cancer were similar between the cohorts. Patients in the 4R cohort were significantly more likely than those in the control cohort to have received a consultation for bone density screening prior to the start of endocrine therapy. They were also more likely to receive a bone density test result during their care. These findings remained significant when data were restricted to those ≥ 50 years (as a proxy for postmenopausal status) and those with ER-positive breast cancer. The rates of osteopenia and osteoporosis were similar between the cohorts: control 47%, 24%; 4R cohort: 46%, 23% respectively (data not shown). Conclusions: Care optimization using the 4R Oncology Model was associated with a significant improvement in the timing of bone density test before initiation of endocrine therapy. The 4R Oncology Model can lead to more informed decision making in adjuvant endocrine therapy for patients with breast cancer. Additional optimizations to improve the rates of bone density tests and referrals will be beneficial. [Table: see text]
Assessment of YouTube as an information source for immune checkpoint inhibitors (ICIs).
Authors: Tulika Garg, Rutvi Chahal, Atulya Aman Khosla, Rohit Singh, Susan Hosny Karass, Rakesh Kumar Sharma, Arya Mariam Roy, Astha Thakkar, Karan Jatwani
Journal: Journal of Clinical Oncology (2023)

11009 Background: YouTube is an open-access source of information. With more than 2.5 billion users, it can play a pivotal role in educating or misinforming cancer patients. ICI has changed the treatment paradigm for cancer over the past decade. There is scarce data to evaluate the quality of information on ICI uploaded on YouTube. We aim to assess the quality and engagement parameters of the 100 most viewed videos on YouTube focusing on ICI. Methods: A systematic search was conducted on YouTube using the search terms (“Immunotherapy AND Cancer”; “Immune Checkpoint Inhibitors AND Cancer”). The 100 most viewed English videos were selected. We utilized the already validated PEMAT 1 and DISCERN 2 tools to assess the quality of these videos on ICI. Additionally, we looked at the number of views, comments, and likes. Descriptive statistics and Pearson correlation tests were performed using R studio v2022.12.0-353. Results: The videos in our study had up to 42 million views (median views: 17,617). These videos were categorized by sources; academic (54%), media (31%), and industry (15%). The mean DISCERN score for the videos was 43.4. Only 22% videos were in the good or excellent category. Most videos (53%) discussed the benefits of ICI, whereas only 29% discussed the adverse effects of ICI. Shared decision-making was promoted by 34% of videos, and only 6.7% of videos summarized the information at the end, based on the DISCERN criteria. The medical terminologies were defined by 48.5% of videos, and 31% were broken into short sections with informative headers per PEMAT understandability criteria. There was no significant association between the video source and video engagement parameters, including likes, views, and comments. However, a trend towards an increased number of likes (r=-0.195, p=0.04) and comments (r=-0.213, p=0.03) was noticed with lower DISCERN scores (poor quality videos). Conclusions: The majority of YouTube videos are focused on the benefits of ICI. They are less likely to discuss the adverse effects or shared decision-making . In summary, YouTube videos contain biased information on ICI. Further efforts from academic institutions are needed to improve the quality and engagement of these videos. 1. Shoemaker SJ et al. The Patient Education Materials Assessment Tool (PEMAT) and User’s Guide; 2. Charnock D et al. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health. 1999. Pearson correlation coefficient (r) between quality assessment scores and video variables. [Table: see text]